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And How Do You Feel About That, Mr. Draper?

We had UCLA-affiliated psychiatrist Paul Puri diagnose TV’s most compellingly mental anti-heroes—and prescribe the treatments that might ease their conditions (but make their Emmy-nominated shows less interesting).

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Homeland
Carrie Mathison
Diagnosis: Bipolar I, traits of borderline personality disorder.
Symptoms: Periods of depression and mania, delusional thoughts, lack of personal boundaries, emotional instability.
Recommended Medications: Mood stabilizers and anti-psychotics.
Recommended Therapy: Mentalization-based therapy, “which helps you recognize mutually opposing beliefs in your head. Like, how do you process the fact that you’re studying this guy and you’re also sleeping with him?”


Louie
Louie
Diagnosis: Mild depression, compartmentalization, self-sabotaging tendencies.
Symptoms: Suppressing parts of his personality, difficulty connecting with others, mild anger issues.
Recommended Medication: A low dose of antidepressants for a trial period.
Recommended Therapy: Role-playing as part of a broader program of psychotherapy. “He might rehearse different scenarios and tease out the things that he does to sabotage his relationships.”


Mad Men
Don Draper
Diagnosis: Alcoholism, extreme compartmentalization.
Symptoms: Difficulty integrating his past and present home and work lives, excessive use of alcohol.
Recommended Medication: “Medications probably wouldn’t do much.”
Recommended Therapy: A sobriety program like AA, plus cognitive behavioral therapy, “but he probably wouldn’t stick with CBT, because it requires you to do homework on yourself. Also, in the period that he lived, that didn’t really exist yet.”


Breaking Bad
Walter White
Diagnosis: Traits of antisocial personality disorder.
Symptoms: Distorted sense of his own power, lack of genuine empathy or remorse, disregard for safety of others.
Recommended Medication: “You could try an SSRI (selective serotonin reuptake inhibitor), but I’d be skeptical that it would do much.”
Recommended Therapy: “Treatment would be tough; he doesn’t see anything wrong with what he does. I would try to get him to explore ways of dealing with what he’s angry about—other than having to run a big drug cartel.”


Girls
Hannah Horvath
Diagnosis: Anxiety disorder.
Symptoms: Excessive worry, low self-esteem, irrational thinking. Recommended Medication: SSRI antidepressants.
Recommended Therapy: “She’s already journaling. She could journal about thought distortions when she notices she’s having them and apply rational thinking.”




Homeland
Sergeant Nicholas Brody
Diagnosis: Post-traumatic stress disorder. Symptoms: Reexperiencing a traumatic event, recurrent nightmares, alienation, limited range of emotion.
Recommended Medications: SSRI antidepressants, and alpha-blockers for nightmares.
Recommended Therapy: Exposure and response prevention (ERP), “so he could deal with his panic in other ways, as opposed to blowing up a room of people, which would be an immature coping mechanism.”


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